03 heunis, kigozi & engelbrecht sahara conference 2009 fin
TRANSCRIPT
Christo Heunis
Gladys Kigozi
Michelle Engelbrecht
Centre for Health Systems Research & DevelopmentUniversity of the Free State
Source: WHO 2009: 81-168
Source: WHO 2009: 81-168
Source: WHO 2009: 28
Source: DoH (2009)
34.8%-33.8%
LejweleputswaThabo Mofutsanyana
Free State
32.2-33.1%
31.1%-32.9%
Source: FSDoH (2009)
32.4%-44.6%
LejweleputswaThabo Mofutsanyana
Free State
37.9%-49.7%
43.1% -45.9%
Source: FSDoH (2009)
63.2%-67.3%
LejweleputswaThabo Mofutsanyana
Free State
63.8%-67.6%
60.3%-65.3%
� Mechanisms for collaboration between TB and HIV programmes
� Intensified TB case-finding among PLWHA
� IPT for PLWHA without active TB
� Improved infection control in health-care and congregate settings
� HIV testing for TB patients
� CPT for TB patients infected with HIV
� Identify factors impacting on uptake/non-uptake of HIV counselling and testing by TB patients from the perspectives of (1) patients, (2) professional and (3) community health workers
� Propose recommendations to increase uptake of HIV testing by TB patients
� Cross-sectional face-to-face interview survey: Feb-Mar 2008
� 61 PHC facilities offering: o TB serviceso HIV counselling and testing services
� Sampleo 600 TB patientso 81 professional health workerso 97 lay health workers
� Voluntary, informed consent
Variable n %
Female 310 51.7
Unemployed 513 85.5
Retreatment 232 38.7
Did (self-reportedly) not receive information on the link between TB and HIV/AIDS
214 35.7
LejweleputswaThabo
MofutsanyanaTotal (%)
Fixed clinics
Manager 4 1 5 (6.2%)
Manager/TB/HIV nurse 6 5 11 (13.6%)
Manager/TB nurse 2 4 6 (7.4%)
Manager/HIV nurse 1 3 4 (4.9%)
TB/HIV nurse 2 1 3 (3.7%)
TB nurse 3 3 6 (7.4%)
HIV nurse 4 4 8 (9.9%)
Mobile clinics
Nurse 5 5 10 (12.3%)
Hospitals
Nursing services
manager4 4 8 (9.9%)
Doctor 4 4 8 (9.9%)
TB nurse 3 2 5 (6.2%)
HIV nurse 2 2 4 (4.9%)
TB/HIV nurse 1 2 3 (3.7%)
Total 41 40 81 (100%)
n %
Lay counsellors 40 41.2
DOT supporters 57 58.8
Total 97 100
� Qualitative: simple content analysis
� Quantitative: uni-, bi-, multi-variate (logistic regression) analysis
* Significant at 5% level ; ** Significant at 1% level
VariableOdds ratio (95% CI)(unadjusted model)
Odds ratio (95% CI) (adjusted for all other factors)
Received TB-HIV informationRef: Not received
3.9 (2.7-5.6)** 4.1 (2.5-6.7)**
Know someone ill with HIV/AIDSRef: Not know
3.0 (2.0-4.3)** 3.5 (2.2-5.7)**
UnemployedRef: Employed
2.6 (1.6-4.1)** 2.3 (1.2-4.3)**
FemaleRef: Male
1.9 (1.3-2.7)** 2.2 (1.4-3.6)**
RetreatmentRef: New
1.8 (1.3-2.6)* 2.0 (1.3-3.3)*
� Shortage of nurses
� Insufficient training on TB/HIV
integration
� Inadequate space for counselling
� Lack of patient trust in lay counsellors
� Re-offer HIV counselling and testing at every
opportunity
� Supply TB-HIV (“the link”) information
� Motivation & support
� Availability of antiretroviral treatment
� TB patients’ fear of HIV, TB/HIV co-infection, death
� TB patients’ fear of anticipated
stigmatisation/discrimination should they test HIV-
positive
� Encouragement and motivation
� Intensifying education on the link between TB and HIV
� Motivating patients in the decision-making process
� Targeting especially males, newly diagnosed and employed patients
� Improving DOT supporters and counsellors’ training and skills
� Public Health Evaluation (PHE) protocol submission to CDC pending: quasi-experiment to implement and evaluate training interventions:
� Training of nurses and clinic managers to scale-up PITC of TB patients
� Training of lay counsellors to provide high quality HIV counselling services to TB patients
� Training of DOT supporters to continuously and more effectively encourage and motivate TB patients to take up HIV counselling and testing
� Funders:
� Department for International Development (DfID, UK)
� National Research Foundation
� University of the Free State
� Authorisation:
� Free State Department of Health
� Collaboration:
� Department of Sociology, University of Antwerp
� American International Health Alliance
� SUNY Downtown Medical Center
� Ethical clearance:
� Committee for Research Ethics, Faculty of the Humanities, University of the Free State
� Colleagues:
� A Pienaar, H Hlophe, M Machere
� Drs P Chikobvu, E Wouters, H van den Berg
� FSDoH. 2009. Tuberculosis statistical reports. http://www.fshealth.gov.za.
� NDoH. 2007. Tuberculosis Strategic Plan for South Africa, 2007-2011. Pretoria: NDoH.
� WHO. 2004. Interim policy on collaborative TB/HIV activities. Geneva: WHO.
� WHO. 2009. Global tuberculosis control 2009: epidemiology,
strategy, financing. Geneva: WHO.